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Haematology and Blood Transfusion Vol. 26
Modern Trends in Human Leukemia IV
Edited by Neth, Gallo, Graf, Mannweiler, Winkler
© Springer-Verlag Berlin Heidelberg 1981
Myeloid Dysplasia: the Histopathology of Preleukemia *
A. Georgii, J. Thiele, and K. -F. Vykoupil
The clinical term "preleukemia" is understood
as an alteration of the bone marrow and
peripheral blood preceding overt acute myeloid
leukemia (AML, review by Saarni and
Linman 1973). However, in the majority of
cases the diagnosis is only a retrospective one,
derived from many mostly clinical and cytogenetic
investigations (Fisher et al 1973 ; Dreyfus
1976; Linman and Bagby 1978; Pierre 1978).
The aim of our study was to determine w hether
there are characteristic lesions of the bone
marrow preceding obvious leukemia and if
wether those lesions are similar in cases
evolving AML or CML later on.
Among more than 15,000 biopsies of the
bone marrow which were performed during
the last 10 years 195 patients were selected
whose examina ti on of the bone marrow was
initiated by the clinical assumption of a possible
preleukemic state. This selection following
the suggested clinical dia gnosis of so-called
preleukemia inherits a problem: there may be
no clear cut separation between a preleukemic
state of leukemia and a myeloproliferative
disorder or CML in early stage or chronic
megakaryocytic-granulocytic myelosis
(CMGM, see Georgii 1979).
Are-evaluation of the semithin sections of
these bone cylinders displayed two different
categories of dis orders : 62 patients had either
nonneoplastic lesions (leukemoid reaction,
12; hyperergic myelitis (mostly rheumatic),
23; pernicious anemia, 11; panmyelophthisis,
3 and other diseases 13 or early stage CML 35
and oligoblastic leukemia 5. The remaining
second category of 93 patients showed distinc-
* Supported by the Deutsche Forschungsgemeinschaft
(DFG Ge 121/19)
tive and identical morphological features of
the bone marrow which probably correspond
to hemopoietic dysplasia of Linman and Bagby
(1978), but should be rather called myeloid
dysplasia, MD, (Thiele et al. 1980a): Histopathology
is characterized by a hypercellularity
(Fig 1a) in most of the cases, a frequently
occurring megaloblastoid and at least macrocytic
differentiation of erythropoiesis (Figs.
1 b, 2a). There are many sideroblasts of the
granular type and a shift to the left of the
neutrophilic granulopoiesis which displays the
so called pseudo-Pelger-Huet anomaly of maturation
(Figs. 2a,b). It should be emphasized
that there is no increase in blasts along the
peritrabecular generation zones of granulopoiesis.
Megakaryocytes are not only increased
but exhibit abnormal cells such as frequent
naked nuclei, micromegakaryocytes, and too
many immature forms (Figs. 1a, 2b). The
myeloid stroma contains a patchy edema and
often a remarkable perivascular plasmacytosis
(Figs. 1a, 2c). Electron microscopy of these
cell confirms these findings and extends our
results of an abnormal cellular differentiation
in MD (for details see Thiele et al. to be
published a).
Gf these 93 patients with the histomorphology
of MD at the time of their first and initial
biopsy, sequential corings of the iliac crest (up
to five times in periods ranging from 2 months
to 3112 years) as weIl as review of the clinical
records revealed that 26 cases evolved obvious
leukemia and the remaining 67 did not show
apparent leukemia until now (Table 1).
Initial main clinical symptoms were mostly
unspecific, ranging from fatigue, loss of weight,
easy bleeding, and pallor to physical findings
such as dermal hemorrhage, slight to moderate
hepatomegaly, and minimal splenomegaly.
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